Abstract
Blood loss after total knee arthroplasty (TKA) is a potentially serious medical problem
since it leads to anemia, increased need for transfusion, and prolonged hospitalization.
Some studies have reported that sealing of the intramedullary femoral canal during
TKA may decrease postoperative blood loss. The purpose of this study is to determine
the effects of sealing of the intramedullary femoral canal during TKA on blood loss
and transfusion rate. Electronic databases, PubMed, EMBASE, the Cochrane Library,
Web of Science, and Chinese Biomedical Database, were systematically searched. Only
randomized controlled trials (RCTs) that compared the sealing group with the control
group during TKA were included up to March 2019. Two reviewers independently extracted
data and assessed the quality of included studies. The statistical analysis was performed
by using Review Manager 5.3 software. Cochrane Risk of Bias tool was used for quality
assessment. Overall, eight RCTs involving 996 patients met our criteria and were analyzed.
The results of meta-analysis showed that patients in the sealed group had less total
blood loss, less total drain output and less hidden blood loss, less transfusion rates,
a lower drop of hemoglobin level at day 1 postoperatively, and less hematoma than
the control group. On the other hand, there were no significant differences in infection,
deep vein thrombosis, and redness of incision between sealed and control group. Current
meta-analysis found that sealing the femoral canal during TKA was an effective method
for the control of blood loss.
Keywords
total knee arthroplasty - blood loss - bone graft
